The information offered below is not meant
to be a consultation or diagnostic of your personal issues.
It is offered only as general background information. You
should always consult an appropriate professional to discuss,
diagnose or treat your personal issues.

A
good place to start is with the teachers. They may work with
hundreds of children in a year. And they are seeing your child
for an hour or so a day, if not longer than that in the younger
grade levels. So, teachers often have a keen sense as to what
is going on with a child when performance is not as good as
expected.

Kids also
can have problems with their hearing and/or vision, and such
issues are not always obvious to the untrained eye. An appropriate
evaluation through an eye doctor or audiologist is advisable.

Sitting down
and talking with your child to get their perspective as to what
is happening and why can also be done. However, with younger
children they may obviously not have the sophistication to look
at themselves that well, much less articulate the difficulties
they face. With older children, such as adolescents and teens,
issues around dating, alcohol and/or drug use, and the many
changes that come with the onset of puberty, can have an impact
on a child’s functioning such as the grades they earn.

Discussion
with the school guidance counselor or psychologist may also
be sought. Use of outside help, such as social workers, psychologists
or psychiatrists, may be needed when none of the above methods
have provided sufficient answers to meet the parents’ concerns.

Asperger's is conceptualized as being part of what
is called the 'autism spectrum disorders.' Some people call
Asperger's 'high functioning autism' while others think they
are not quite the same. There is also some debate if Asperger's
and non-verbal learning disability (NVLD, which is discussed
elsewhere on this page) are different names for the same problem,
or if they have some subtle differences.

But
in general Asperger's involves impairment in some key
areas of functioning. Perhaps the most important is that social
skills are markedly deficient. Individuals with Asperger's
have a much harder time understanding how to interact with
people. They seem disinterested or oblivious, and often have
few if any friends. If they desire friends, it's hard for them to make and keep any, because what they say and/or do is socially inappropriate. They often invade the personal space of others without realizing that it is not being appreciated. They talk 'at' rather than 'to' others. That is, their conversations are effectively monologues often about a peculiar topic that most people would have no interest in. They also typically do not like participating in social activities like team sports. Eye contact is poorly made.

Additional
behaviors that are common with Asperger's include having a
very narrow and restricted range of interests. Often these topics have to do with transportation, other aspects of science, or dinosaurs. They can become fixated
by trivial behaviors, such as playing with a lace on their
shoe for an hour at a time. In relative terms to autistic individuals, language skills are near normal. But, some qualities of their language are still impaired. They have a difficult time understanding elements like tone and inflection which can communicate the speaker's feelings such as if they are happy or angry. Or, they will take statements too literally and so misunderstand idioms or humor. There also can be a stiffness and formality to what is said, rather than being able to talk on a more casual and conversational level. Poor motor skills are also common. I often hear that kids who are even in to their teens have never learned how to ride a two-wheel bike and have no interest to do so. Poor attention to details is common, and a good percentage of kids with Asperger's have been diagnosed with attention deficit disorder (ADHD). Some also are overly sensitive in their senses, such as taking an hour to get socks to feel right on their feet because the seams bother them. Or, shirt tags are bothersome. Some kids cut them out, or go so far as to wear shirts inside out so as not to have the tags touching their skin. Sound can also be upsetting, such as sudden noises like a dog barking. Others are upset with high pitched noises like from kitchen appliances. A third type of noise that some find overly bothersome might be described as the babble of crowds of people such as at a party. These problems are at a level
where they impair normal functioning in areas such as socially,
academically or occupationally.

Individuals
with Asperger's are not mentally retarded. If anything, they
can be very smart but they may lack social finesse in how
it is displayed. Or, their gift for intelligence may be limited
to a very narrow area, such as some aspect of computers or
other skill which typically does not involve much if any social
interaction.

Treatment
of Asperger's is based on a symptomatic and common sense approach.
Developing social skills through practice is an important
step. Medication can also be used to address some of the problems,
such as poor attention or impulsive behavior. For more information
on Asperger's, consult the Resources page of this web site.

Neuropsychological
assessment looks more specifically at what are called brain/behavior
relationships. Common problems include skills like memory
or attention being impaired. Or, executive skills may be deficient.
Executive functions can include abilities such as organization
and planning; getting started or persisting as needed; stopping
when appropriate rather than doing something ad nauseam;
being able to monitor for, catch and correct mistakes in a
timely manner; and problems with emotional control such as
having a short fuse. Neuropsychological assessment can be
helpful in figuring out such issues, and what may be causing
them.

Difficulties
with executive skills, like those noted above, are probably
the largest factor for why some people do so poorly in their
daily functioning. That is, they may be very bright, such
as kids making good grades. Or, adults may have a higher than
average IQ. But, their ability to function in an age- and
role appropriate manner, and at a level that is commensurate
with their innate potential, may be much worse than expected.
For example, parents may note that their child is doing homework
and understanding the concepts such as the different principles
of math. But, the child loses the assignment, or forgets to
turn it in. Consequently no credit is received, and the resulting
grade for the year may be a D or F, when the child is capable
of much better marks given the knowledge they possess.

Adults
who are having such problems may be explosive in temper, to
the point of their spouse, children or others not being able
to tolerate them any longer. Or, they may be so disorganized
that similar to what was noted above for kids, they may have
an ability but not be able to demonstrate it effectively such
as to their employer. This might be noted such as by losing
assignments, or coming in chronically late to work.

Neuropsychological
assessment can be done on any number of suspected problems.
A few of the common difficulties include attention deficit
disorder (ADHD), dementia such as from Alzheimer's or strokes,
and brain injury such as arising from car accidents.

How
long the total assessment lasts varies with the type of issue
being evaluated, as well as the person's age. For young children,
such as 6-8 year olds, I figure that they will last no more
than 1 - 1 1/2 hours during a session. Some of that time is
spent with the parent(s), discussing background history and
their concerns, but the child is still wearing out in the
process. Younger children tend not to tolerate multiple sessions,
and so I try to keep the total evaluation to just 1-2 sessions.
With adolescents, perhaps 9-12 years old, I find that most
can tolerate 2 - 2 1/2 hours at a time. And, if it's needed,
2-3 sessions may be done to get a complete understanding of
their issues. With teens and adults, sessions can be as long
as 3-4 hours, and for most just 1-2 visits are needed. With
older individuals who may be dealing with dementia, I try
to limit the evaluation to a single session, and typically
just 1 1/2 hours or so. With much older people, such as those
who are 85-90, an even briefer amount of time may be all they
can tolerate.

The
cost for such services, whether paid for by insurance or the
individual, also varies with the extent of the evaluation.
I often offer a range of what the expected cost will be, because
it is difficult to know in advance just what and how much
needs to be assessed until we have had a chance to meet and
start discussing your issues in greater detail.

To be more specific: I have worked with some insurance plans where there is no co-pay, no deductible, and hence no cost to the individual. Other insurance plans have had yearly deductibles as high as $2500. - which means that none of the costs of an evaluation will likely be covered, unless the individual already has used a great deal of mental health services. Most commonly, co-pays for those with insurance range from $5. - $50. per session. Most deductibles I see are between $0. - $300. per year. For those without insurance, cost again can vary widely. I try to work with such folks and keep their expenses down as much as possible, doing enough to get them help but not so much that the bill goes through the roof. Typically the cost then ranges from perhaps $350. - $1000.
back to top

I
think my child has attention deficit disorder (ADHD). How can
I tell?

Much has been written about ADHD, and many parents are familiar
with some of the common signs of it. There is a need to be careful,
and not jump to conclusions. Other difficulties that can look
like ADHD include anxiety, depression, trauma to the brain (such
as from car accidents, organized sports, various types of falls,
brain damage from diseases like infections), manic depression,
and substance abuse.

The list
offered below are some of the more common symptoms which can
be suggestive of ADHD. They are not meant to be diagnostic,
and no one should conclude that ADHD is the culprit based solely
on some or all of these symptoms being present.

Family
history of ADHD (parents, siblings, or other close relatives
having been diagnosed with the disorder, or strongly suspected
of having it, if not formally diagnosed with it)

School
teachers raising the possibility of it being present in
the child

Attention
span being short, such as a few minutes to a half hour perhaps,
for non-entertaining activities. That is, the person may
be very attentive for hours on end watching television,
or playing video games, but have minimal attention span
for tasks like listening in class, or doing homework.

Distractibility,
so that the person gets easily side tracked on to other
activities, and has a hard time finishing tasks that are
started

Disorganization.
A child’s room being messy is probably a universal
complaint of parents. But, some kids are far messier than
their peers. Other types of disorganization often include
doing homework but forgetting to turn it in, or losing it,
so that no credit is received. Or, losing personal items,
sometimes permanently, such as clothing, wallets, watches,
jewelry, books, etc.

Having
knowledge in one’s head, but having a difficult time
getting it on to paper, such as for writing assignments
or during tests.

Being driven, ‘on the go’ or unable to sit still
for long. This can range from being fidgety and squirmy
in a chair, to getting up and walking around a classroom,
to being antsy and getting up many times and doing something
else while watching a television show or movie.

Taking
much longer to accomplish homework than is expected. For
instance, what typically takes the average student thirty
minutes to accomplish may require 3-4 hours, and even that
may be with considerable support and supervision from parents.
Or, among older children, such as in high school or college,
what should take perhaps 2-3 drafts of writing to accomplish,
may need ten or more, with that much more time taken to
do it.

Difficulty
making and/or holding on to friends. With older individuals,
jobs may be lost due to being late, inattentive, or disorganized
to the point that the employer can not tolerate such problems
occurring so frequently.

Psychological
testing for such individuals can help diagnose ADHD and determine
if other issues, such as learning disabilities, are present.
Testing can also determine if the same symptoms are being
caused by some other factor which may require a different
treatment approach.

My
child has been diagnosed with ADHD. What are your thoughts about
medication?

Medication
for ADHD has been used for several decades now, and there is
a considerable amount of data on it. Research has shown that
it is effective in helping most ADHD individuals to some extent.
The ability to pay attention substantially improves in most
people, and the beneficial effect occurs within 15-60 minutes
or so. Grades for kids typically go up by two points in my experience
(e.g. a child making D's and F's rises to B's and C's, or a
C/D student improves to an A/B one). IQ's also increase by roughly
10-15 points on average. This is not because the medication
makes them smarter. Rather, it allows them to function at their
innate potential, without penalty from problems like distractibility
and poor attention. Teachers who are unaware that a student
has started medication are typically heard to say 'What's changed?'
because the student is doing so much better all of a sudden.
And I've heard many parents state that they can tell when their
child has forgotten to take a dose on some day because their
behavior is so much worse. That's the good news.

The bad news to medication is that there are side effects which
can be troublesome to some kids. Problems with weight loss can
be an issue. Other kids may become nervous, or have difficulty
sleeping. Sometimes a child will become much more quiet, and
have less sparkle to their personality. At this time, the medications
are generally thought to be safe for long term use, but absolute
certainty about this is lacking. The obvious example of such
an issue is what happened with hormone replacement therapy (HRT)
for post-menopausal women. Millions of women took HRT over the
past several decades, on advice from their doctors. The pills
were thought to reduce the risk of various diseases. Recently,
the medical establishment said 'Oops, we made a mistake. HRT
causes more disease than it prevents.' The simple truth is that
to get definitive research on any subject can often take 35-50
years. Consequently, at this time ADHD medication may be presumed
to be relatively safe, but the jury is still out in terms of
absolute certainty.

Dietary
approaches have been suggested since the 1970's, when ADHD
was blamed on too much sugar and junk food. They were disproved
back then, but the idea seems to be making a resurgence. Some
people are more sensitive to sugary junk food, and may well
'bounce off the walls' when it is eaten. Improving your child's
diet and teaching them good nutritional habits is always advisable.
There is growing concern now in medicine, typified by articles
in papers and magazines, about childhood obesity and diabetes.
Too much junk food is at least partially responsible for these
problems. So, I'll always offer encouragement to parents to
reduce junk food for their kids. But research to say that
an absence of junk food will cure or substantially reduce
ADHD is lacking at this time.

There
also was some recent research, done on 3 year olds, suggesting
that too much food preservatives, such as sodium benzoate,
may be a culprit in causing ADHD. Food coloring also has been
suggested as a factor for causing ADHD. But, I have seen no
other research to back up the theory at this time.

Many
parents are more comfortable with the idea of using natural
substances, such as vitamins and minerals. The idea is appealing,
but definitive research is lacking on this approach. And I've
yet to have a single parent in the last 20 years tell me that
it has worked for them, and cured or substantially improved
their child's ADHD. Caution is also advised, because 'natural'
supplements are by no means always safe. Prescription medication
has to prove through scientific research that it is safe before
it is allowed on the market. The law says that natural supplements
have to be proven to be dangerous before they are pulled off
the market. Ephedra is perhaps the best known recent example
of this law, where people became ill or died before the substance
was taken off the shelves. You should always consult a physician
before use of such supplements.

Behavioral
approaches exist, such as use of rewards, punishment, time
outs, token economies, or just more structure and supervision.
Little if any research has found behavioral methods to be
effective for ADHD when done in isolation. I've never once
heard a parent in my office say "This works!" Instead,
I've heard the opposite: "We've tried everything, and
nothing has worked. Now what do we do?" Behavioral approaches
used in conjunction with medication can be helpful to some
kids.

There
is also some recent research which has suggested that infants
who watch too much television are actually causing their brains
to change on some neurological level, leading to ADHD. However,
there already has been a rebuttal to such a theory, which
basically raises a 'chicken or egg' question to it. That is,
does television viewing lead to ADHD? Or, do infants and young
children who have ADHD simply watch more television? Which
comes first is not known at this time.

It
also has been suggested that video games are causing ADHD
to some extent. Computerized brain imaging has been done on
people who were playing video games. What was found is that
an area of the brain called the basal ganglia are activated
during such games, and dopamine, one of the brain's chemicals,
are released in the process. Dopamine is involved with a number
of brain functions, including attention span, focus, and motivation.
It is thought that the video games effectively use up the
dopamine for awhile, and so it is not available when needed
such as for doing homework. In my opinion, playing video games
is like eating junk food: they may be fun, but there are better,
more wholesome choices available. Reading, playing, or socializing
with other kids in various ways are all better than video
games in my opinion. Whether cutting down or eliminating video
games from your child's daily routine will make a substantial
difference in ADHD symptoms can only be determined by trying
it. And enforcing the rule can be difficult, given that you
may stop the game playing at your house, but not elsewhere
such as at a friend's.

Exercise
is another option. The research on physical fitness enhancing
school performance dates back at least to the 1970's. 'Physical
fitness' typically has been measured by looking at kids who
get a certain number of hours per week in phys. ed class
versus those who get little or none. With appropriate safety
precautions, supervision, and use of exercises that are right
for a child's age, everything that I have seen says that exercise
is beneficial. Much like good diet and nutrition being something
that should be taught to a child and maintained throughout
their life, exercise is another key to maintaining good physical
and mental health. But, this is not a case where your child
can go outside, run a lap around the block, and be instantly
and permanently cured of ADHD. Appropriate exercise, such
as offered by a gym teacher, done regularly and consistently,
may help a child in terms of better attention and grades.
Much like video games being cut back, whether exercise will
substantially improve ADHD symptoms for your child can only
be determined by trying it.

There
is also something called 'neurofeedback' or 'biofeedback for
the brain.' Biofeedback has been around for many years, and
is known to be effective for helping a number of problems.
The idea behind neurofeedback is that there are several different
types of brain waves in all of us. These include being asleep,
almost asleep, alert but relaxed, and alert and mentally active
such as when doing school work. The brain waves of ADHD individuals
are often found to be in the 'almost asleep' stage, even though
their bodies are awake. Hence, their poor grades and general
functioning. The basic theory behind neurofeedback being used
to treat ADHD is 'Why change the brain chemistry through medication
to influence the type of brain waves present? Just change
the brain waves themselves.'

Neurofeedback
involves using a simplified EEG machine, and uses a video
game format to offer feedback to the person. (The video games
I've seen for neurofeedback have no 'blood and guts' to them,
and are more like Pac-Man). The games are controlled by brain
waves, not joysticks. If the person has the right kind of
brain waves - active and alert - points are earned. With the
wrong brain waves (almost asleep) points are lost, or not
earned.

The
problem with neurofeedback being used to treat ADHD is that
there is limited research on it. A modest amount has been
done on it since about 1990. It is also considered to be experimental
at this time, so many insurance companies will not cover it.
Neurofeedback is typically done 2-5 times a week, and may
need 2-6 months before results are seen. The cost of a battery
of sessions is typically $2000.+ The number of practitioners
who are doing it in North Carolina are also very limited.
(One web site for neurofeedback lists five people, in Asheville,
Greensboro and Charlotte, as being the only professionals
within this state who are trained in it.)

What's
wrong with being ADHD? Isn't it a way of saying that someone
is just an active child?

That
may be true at times. ADHD tends to be over diagnosed, under
diagnosed, or misdiagnosed. But what is now called ADHD has
been recognized for about 100 years, under different names.
And current research keeps finding that when ADHD is present,
many other problems tend to surface. There is a high incidence
of learning disabilities that are associated with ADHD, because
it is thought they involve the same chromosomes. Other difficulties
arise which can cause trouble for a child or adult with ADHD.
Higher rates, often 2-4 times greater, are found for:

Kids dropping out of school, which has consequences for
the rest of their lives.

Becoming involved with nicotine, and possibly alcohol and
illicit drugs.

Being in a car accident. Such accidents may be only a fender
bender. Or, they may involve injury, disability or death
to your child and/or someone else on the road. The elevated
risk of being in an accident is measured against other teen
drivers, who are known to have a high rate of collisions.
So the inexperience for driving and the impulsivity of youth
are being compounded by ADHD being present in a young driver.

Sexually
dangerous behavior is greater, which may lead to unwanted
pregnancy, or contracting HIV or other sexually-transmitted
diseases.

In early adulthood, ADHD individuals have a higher rate
of quitting or being fired from jobs, which has implications
to their being able to support themselves and a family.

Separation or divorce.

Arrest rates.

Problems
with emotional functioning, such as stress or depression,
are increased.

How
can I tell if I’ve suffered a brain injury from a blow
to my head?

Many patients
I see do not realize for several months that they are having
various problems such as with memory or concentration. Such
impaired functioning can be subtle, and may not be easily spotted
until they attempt to return to their prior functioning, such
as work. At that time it may be noticed that they can not function
like they were able to prior to the head injury.

Some of the
common symptoms that a head injury may have occurred include
(these are not meant to be diagnostic by themselves):

Loss of consciousness

Feeling
dazed or confused for some period of time, which can range
from seconds or minutes, to hours or days.

Headaches
that arise after a head trauma, and persist, perhaps for
days, weeks, months or years

Problems
with short term memory

Problems
with concentration, and paying attention

Personality
changes, such as being more depressed, irritable, angry,
short tempered

Changes
in sleep patterns

Reduced
social interest and having less contact with others

More
easily fatigued

There
are different ways that traumatic brain injuries (TBI’s)
can be diagnosed. Typically the first potential way to do
so is during a visit to a medical doctor, such as the emergency
room right after the accident. However, in the vast majority
of cases that I see, nothing is found at that time, even when
a TBI has occurred. Such ‘false negatives’ are
common because the amount of time spent with patients is typically
quite brief. Plus, brain damage may not even have occurred
yet when the patient is in the ER. Damage may only start to
occur, and be noticed, after a day or two if not longer.

Another
factor that makes ER doctors miss a lot of diagnoses of TBI
is that they are looking more at the structure of the skull
and brain such as through x-rays, CAT or MRI scans. Is the
skull fractured? Is there bleeding inside the brain? They
have minimal ability, given the brevity of most ER visits,
to discern if the functioning of the brain has changed. Many
patients I see do not realize for several months that problems
have occurred. Such impaired functioning can be quite subtle.

Neurologists
are also capable of diagnosing TBI’s through an appropriate
evaluation which may include tests such as an EEG, which records
brain waves. However, neurological evaluations tend to focus
more on the ‘lower order’ functioning of the brain,
typified by whether or not various reflexes are working properly.
If such reflexes are impaired, a serious problem may exist.
If they are functioning normally, the ‘higher order’
functions of the brain, such as memory, concentration and
ability to think in ways needed for daily living, may still
be adversely impacted.

Neuropsychological
testing is a third means to evaluate for TBI’s. Its
advantage is that it does assess these higher order intellectual
functions, which is where the patient is typically having
complaints of reduced functioning. However, other factors
also need to be considered in doing these evaluations. Personality
issues, such as depression or anxiety, may be at least partially
responsible for problems with intellectual functioning. Other
factors, such as if a person starts to drink too much alcohol,
as a form of self-medication, can impact a person’s
functioning. Medication side effects, such as narcotic pain
killers, or muscle relaxants, can also take their toll on
functioning. Consequently, there needs to be a careful evaluation
of a person’s issues to get an accurate understanding
of what has occurred.

My
parent/spouse has become very forgetful. Is this Alzheimer’s,
or some other form of dementia?

Maybe, but
not necessarily. Short term memory loss, so that a person forgets
what is said to, or heard from, others within seconds (or minutes,
hours, or a day or so) can be due to a number of different causes.
These include:

Depression.
Older individuals typically are losing to death people very
close to them (their own parents, siblings, spouse, life
long friends, and sometimes their own children). They typically
have declining health, may have multiple diseases, and might
be facing a terminal illness such as cancer. Many older
individuals are socially isolated, whether they are living
in their own homes, a nursing facility or assisted living
center, or senior housing. That is, they feel like they
have been largely if not entirely forgotten by society as
a whole. Given such facts, depression is often present but
can be easily missed. Elderly individuals have a surprisingly
high rate of suicide. Depressive factors can impair memory
functioning. It is possible to treat depression, and restore
some or all of the lost memory functioning in the process.

Diet. Older individuals may eat minimal amounts of food (‘tea
and toast’). Or, they may eat normally, but due to
increasing age they do not metabolize nutrients as well
as when they were younger. Consequently, it is possible
to have nutritional deficiencies result. A family physician
should be consulted if this is suspected.

Drinking.
Older individuals often go unrecognized when they in fact
are abusing alcohol. The amount that has to be consumed
to be a problem for older individuals is less than for someone
younger, given the effects such as from aging, interactions
with medication, and a slowed metabolism.

Medication. Increased
use of medication typically comes with increasing age. Older
people may be taking 8-15 medications, for any number of
health problems. Side effects from drugs, either individually,
or through interactions with other pills, can cause difficulties
with memory, concentration, and general thought processes.
Having a discussion with the treating physicians about medication
and potential side effects may be helpful.

Dementia is an increasingly likely possibility as people age.
For instance, estimates have been made that only 3% of individuals
at age 65 have Alzheimer’s. But, by the age of 85 roughly
50% are thought to have that disease. Another common problem that can
impact memory are strokes, which are often ‘silent.’

How
can I tell if my child is depressed? How is it best treated?
Depression in children can show itself in different ways than
in adults, and it is may not be as easy to spot. One of the
key differences is that the emotional display of depressed kids
may be anger or irritability, rather than depression per se.
Many kids can have wide mood swings as part of their normal
personality. With adolescent development and puberty in particular,
such mood swings can become larger and wider, and many parents
have a difficult time figuring out if the volatile temperament
is 'just normal teenage rebellion' or something more serious,
such as depression. Differentiating between these two possibilities
is important, because depression carries with it a higher risk
of suicide. Suicide is the third leading cause of death among
teens in the U.S. It has been estimated by the Centers for Disease
Control (CDC) that 1 of every 12 high school students had attempted
suicide in the preceding twelve months.

One
way to determine if your child is depressed is to look at
some of the symptoms that are common between both adults and
children. These include 'vegetative' signs, such as changes
in sleep or appetite. Depression affects people in different
ways. That is, some individuals may sleep or eat too much,
while others have too little. It is not so much the amount
of sleep or appetite that is occurring but that there has
been a major change from what used to exist. Parents also
can look at energy and activity level. Has the child become
a couch potato? Are they showing less interest in school or
friends? Is there more crying than there used to be? Are comments
made such as 'I might as well be dead' or 'What's the use
of living?' All of these can be evidence of childhood depression.

Depression
in kids can be treated through at least three common approaches.
One is medication. There is currently a large controversy
about how safe it is to use anti-depressant medication on children.
There is some suggestion that such drugs can lead to an increase
in suicide. The question has yet to be definitively answered.
Naturally, many parents are concerned about the possibility
of an anti-depressant further endangering their child, and
so are leery about using them as a result. Consultation with
a medical doctor of your choice, such as a pediatrician or
child psychiatrist, is advised to further discuss this issue
and answer questions you may have.

A
second approach is what adults call physical exercise, and
kids might term 'running around having fun.' This can entail
activities like playing on team sports, riding a bicycle,
or joining in a game of tag. It has been known for about thirty
years that physical activity can reduce or eliminate depression
in people. More recent research has found that exercise can
be as beneficial as medication in its antidepressant effects.
The added bonus to kids engaging in such play is that it is
typically done with other children, and they can develop more
and better friendships, which has its own benefit for beating
depression. Moreover, getting kids off the couch and out of
the house helps prevent them from moping around and feeling
sorry for themselves. That is, physical activity can take
their minds off their problems and get them engaged in having
fun and socializing with other children.

A third approach is the use of talk therapy. Cognitive-behavioral
therapy (CBT) has been around for over thirty years, and is
continually found to be effective for treating depression.
Briefly, what CBT entails is the idea that thoughts and feelings
are a two-way street. That is, how you feel can influence
your thoughts. And the opposite is also true: how you think
can impact what you feel. And, thoughts are easy to change.
A simple and common example of this is the perspective people
take on their life, such as it being 'half empty' or 'half
full.' A variation on this concept can be found in books like
'The power of positive thinking.' CBT is also considered a
brief therapy, with perhaps 8-13 sessions being needed to
learn how to use it effectively. There are many books written
on the subject, and there are a multitude of web sites which
have information on it.

Still
other approaches to dealing with depression can include play
therapy for children who are too young to be comfortable
or skilled in talking at a level that is needed for cognitive
therapy. There is also some limited amount of research which
suggests that acupuncture might be helpful in treating depression.

How
can I tell if my child is dyslexic?
Dyslexia is not always easy to diagnose, because younger children
often reverse letters (such as ‘b’ and ‘d’
or ‘p’ and ‘q’). With increasing age,
such as by 2nd or 3rd grade, such reversals should diminish
and eventually cease for a child who is not dyslexic. However,
other difficulties with language processing can also be part
of dyslexia. Common difficulties include:

The
ability to pronounce words fluently and normally, rather
than slowly sounding out words by phoneme or syllable

Spelling being extremely poor, such as having no vowels
at all in words. Or, wildly inaccurate renditions (e.g. ‘chair’ becoming “qtz.”)

Writing
being slow, labored and slavish such as in copying material.

Math
problems may see numbers reversed in sequence (e.g. '103'
becomes '013'), or they may be inattentive to the operation
required (such as adding when subtraction is needed).

Given
the importance of reading in general, and as a primary means
for learning in school, diagnosing reading difficulties is
very important. Generally, the sooner such a diagnosis is
made the better, in that the student will not have fallen
as far behind. Another reason for helping a dyslexic as early
as possible is that the brain is most receptive to developing
such skills for only a limited number of years. By roughly
4th or perhaps 5th grade, the neurological wiring of the brain
for language skills like reading is fairly complete. Consequently,
it is far harder to learn those skills after such an age.
Over the years I have seen hundreds of individuals, or their
parents, who have told me that they were 'shoved through the
school' without ever learning how to read. Most have tried
to learn to read as adults and have had at best limited success.
It is possible to learn how to read in later years, but it
is far easier during the early grade school period.

Dyslexia
takes a toll on people in other, more subtle ways. One of
the most common is that individuals can develop low self-esteem,
become depressed, or think of themselves as being stupid.
Not being able to read in our society exacts a high price
not only within a school setting, but in other ways such as
filling out job applications, understanding highway signs
while driving, or even as a parent reading to a young child.
Most dyslexic individuals I see have experienced such failures,
and feel embarrassed, ashamed or otherwise inadequate - although
their suffering is almost always born in silence.

What
are executive (or, 'frontal lobe') skills and what can affect
their function?

The
frontal lobes can be thought of as the most advanced part of
the human brain. In simple terms, they are largely responsible
for differentiating people from the so-called 'lower order'
of animals, such as alligators, horses, cats or guinea pigs.
Most animals are limited to acting through little more than
instinct and reflex. The ability to think, create novel ideas
and products, develop insight and self-awareness, and function
in more abstract ways such as through sense of morality or law,
are all frontal lobe skills.

A
different way of thinking about the frontal lobes is that
if you look at a desk top computer you will inevitably find
a blizzard of wires connecting the many components (monitor,
speakers, internet connection, keyboard, mouse, etc.) together.
What would happen if all those myriad of connections were
not plugged in to the back of the computer? Information on
the internet could not be transferred to the hard drive. Thoughts
typed on a keyboard could not be displayed on the monitor.
Sound from a music file could not be heard through speakers.
The frontal lobes are like the 'mother board' or main CPU
of a computer, in terms of linking together the many diverse
elements of the brain so that information can be exchanged
and acted on in far more flexible ways, rather than only mechanically
and instinctually as happens with the lower order of animals.

There
is some down side to the frontal lobes, which is where problems
arise. One is that wherever there is complexity of function
and operation, there is the potential for it breaking down
or not functioning correctly for other reasons. The frontal
lobes can be affected by a number of factors that occur all
too frequently. These include attention deficit disorder (ADHD),
traumatic blows to the head such as from car accidents, various
diseases such as infectious agents, oxygen deprivation (from
problems arising like drowning, heart attacks, or strokes).
Aging can also take a toll, in terms of cell death occurring
for natural reasons, as well as from factors like high cholesterol
plugging up blood vessels.

Yet
another reason that people run in to trouble around the frontal
lobes is that they do not develop on a neurological level
as quickly as we might like or need. They are probably not
neurologically mature on average until a person is roughly
25 years old. Often I see teens or individuals in their early
20's, and males in particular, who have qualities such as
being impulsive, reckless, acting without regard for potential
consequences or without due consideration toward others. I
call such behavior 'too much testosterone, too little frontal
lobes' and there is much truth to that description. In effect,
hormones are creating an overly strong gas pedal, and the
under developed frontal lobes of young adults do not create
a sufficient balance in 'braking' such behavior.

Non-verbal learning disability (NVLD) has some overlap with
attention deficit disorder (ADHD), such as being inattentive
and disorganized. There is also some debate among professionals as to whether NVLD and Asperger's are the same disorder, or if there are subtle differences between them.

There are
a number of other common symptoms to NVLD, which typically are
not found with ADHD. (The following are not meant to be diagnostic,
and no one should conclude that NVLD is the culprit based solely
on some or all of these symptoms being present.)

Difficulties
in math, which may include the spatial elements such as
lining numbers up appropriately in columns such as for multiplication
or division

Poor coordination, such as for organized sports, riding
a bicycle, or being overly clumsy

Poor
social skills. This may include not being sensitive to nonverbal
communication (e.g. body language). Or, being socially awkward,
maladroit, ‘geeky’, uncomfortable and stiff
when in the presence of most other people. Few close friends
may exist.

Poor
sense of direction, such as in reading a map, driving a
car, getting lost in the neighborhood when walking or riding
a bike, etc.

A
relative strength in language skills, with reading probably
the first to be obvious.

Formal assessment can help
to identify these issues, which can have a major impact on
a child's social, emotional and academic development. My attitude is that which particular label (Asperger's, NVLD, ADHD) is used is mostly moot. Instead, the focus should be more on the symptomatic treatment that will help the child develop as needed. For instance, NVLD and Asperger's both involve pronounced social difficulties, and the difference between them may be likened to varying shades of gray. What is more important than obsessing over a diagnostic label is to help the child develop better social skills, make friends, and be more comfortable dealing with others. Similarly, whether a child is purely NVLD or also qualifies for an ADHD diagnosis is mostly moot. If attention is impaired, regardless of the diagnostic label, the same types of medication that works for ADHD can be employed with NVLD. I do want to say that the diagnosis can be important in certain situations, such as qualifying for additional accommodations in school.

Another point to keep in mind is that kids with NVLD can grow up to be normal, well adjusted and high functioning individuals. Everyone has strengths and weaknesses, or some skills that come easily and others with greater difficulty. The types of strengths and weaknesses of a NVLD child are different than someone who does not have the disorder. But what parents have to keep in mind in raising any child is always the same: improve the weak areas so that they are hopefully at least near average, and capitalize on the natural strengths so that they become even better. The areas that are weaker with NVLD individuals, such as social skills or spatial abilities, may never come as easily and fluently as for others. But, struggling a bit with such issues does not preclude a person from learning to drive a car, getting married, or working and supporting themselves and a family. For more information on NVLD look at the Resources page on this site.

What are seizures? What causes them?
And are there emotional or intellectual complications to having
them?

Seizures involve an abnormally
high amount of electrical activity in the brain usually for
just a brief period of time. In simple terms, they can be thought
of as being like ‘spikes and surges’ that sometimes
occur in a home’s electrical wiring system, so that there
is too much voltage for a moment.

As
to what causes seizures, there are literally dozens of possibilities.
For about two-thirds of people, seizures occur for no known
reason. All we can say is they just happen. For the third
of individuals who have them for reasons that can be determined,
some of the more common causes include:

Traumatic
blows to the head (such as from car accidents; falls off
a ladder or bike, or down stairs; assaults; sports-related
injuries such as from baseball, soccer, hockey or football,
etc.)

High fevers

Brain tumors

Strokes

Use
of various legal and illegal substances such as alcohol,
cocaine, or amphetamines

There
are a number of different types of seizures. Probably the
most widely known are ‘grand mal’ seizures which
involve a person losing consciousness usually for a few minutes,
and having considerable jerking and contractions (convulsions).
Much if not all of the brain may become involved in grand
mal seizures. Another type is ‘petit mal’ where
a smaller region of the brain has excessive electrical activity.
The person remains conscious, but is in an altered state of
awareness. They may not be responsive to others such as someone
talking to them. Paranoid qualities, such as turning their
head to look when nothing is there, may occur.

A
third type, which I see quite often, is more controversial,
and harder to diagnose. It involves what are called ‘sub-clinical’
seizures, which I refer to as being ‘little electrical
blips.’ Such sub-clinical episodes are analogous to
pre-cancerous cells – a state half way between normal
and full blown cancer. The little electrical blips are effectively
part way between normal brain activity and a full blown seizure.

Most
commonly the symptoms that are suggestive of these sub-clinical
episodes occurring involve odd sensory experiences. These
might include seeing shadowy, ghost-like visions out of one’s
peripheral vision. Or, hearing one's name called out when
no one is talking to them. Other common symptoms include noticing
unusual smells for no apparent reason, or a having a sense
of bugs, where none exist, crawling on one or more areas of
the body.

People
may not be fully confident that they are having such odd sensory
experiences. For instance, a person might see shadowy movement
out of their peripheral vision because it is a hallucination
triggered by a sub-clinical seizure. Or, it may be seen because
there was a real shadow for a moment. My rule of thumb is
that having just one or two of these symptoms reduces the
likelihood of there being a cause for concern. When a person
endorses a large variety of odd sensory experiences, and also
has a history of various types of traumatic blows to the head
having occurred, I become more suspicious of the possibility
that such little blips are the culprit.

Ideally,
neurologists should evaluate for all seizure concerns. Other
professionals, such as family doctors, pediatricians, psychiatrists
or neuropsychologists might also be used to diagnose the presence
of seizure activity.

As
to the complications that seizures can cause: most individuals
who have them lead normal lives. A rule of thumb is that

The less often a seizure occurs

The smaller amount of brain tissue it involves (e.g. a petit
mal involves less brain area than a grand mal)

And the better control that medication permits

then the less likely there will be significant adverse effects
from seizures existing.

Having
said that, there can be subtle effects that seizures may cause
the individual, even when the three bulleted points noted
above are in the favorable direction. Depression occurs at
an elevated rate, with roughly a third of all seizure patients
having such a problem. Manic episodes also may happen more
frequently than in the general population, but not as often
as depression. Individuals may have poorer short term memory,
slower thinking, greater difficulties with social skills,
or decreased or increased sexual drive.

I'm
wondering if my teen is drinking alcohol or using drugs. How
do I find out?

In
my experience most parents have good hunches as to where problems
lie with their kids. If you are suspicious that substance
abuse is occurring, the odds are that it is. In some cases,
there may be a genetic component in families, where the parents
and/or various relatives have a history of substance abuse.
Genes are powerful, and the risk of having a disorder, such
as substance abuse, always increases when genetic factors
are present.

However,
most often I find parents who are caught by surprise that
their kids are drinking or using drugs. That is, the parents
are usually the last to learn of the substance abuse. It's
like being in a car accident, or diagnosed with a disease
such as cancer: we think 'It only happens to the other person.'

There
are a couple of ways to figure out what might be happening
around substance abuse and your child. The first and most
obvious approach is to talk to them. Some kids may be open
on the subject. Most won't, and do a pretty good job of hiding
the truth from parents. A second approach is to consult with
a professional who is experienced with substance abuse. In
my experience, adolescents, and older teens to a somewhat
less extent, will typically tell a doctor personal matters,
such as substance abuse, that they hide from their parents.
When kids are less than fully disclosing on the subject, professionals
who are experienced with substance abuse can usually figure
out at least the basic outline of what is probably happening.

A
third approach is to pay attention to possible signs. A drop
in grades is common. Major changes in personality, such as
suddenly being more depressed, angry, or having significant
changes in behavior like sleep patterns or appetite might
also be reflective of substance abuse. Obviously, other factors
might cause a child to undergo personality changes, such as
from the effects of puberty, breaking up a dating relationship,
parents divorcing, etc.

A
fourth approach is to force alcohol or drug testing on a child.
I come across almost no parents who take this approach. It
may give you the information you want. But there are some
problems with it. One is that it creates considerable hostility,
distrust and impediments to communication between parent and
child. A battle of wills, anger, and resentment can all result.
And you have to do the test while the substance is still in
their system. If a teen is getting intoxicated at a party
on Friday night at 10 PM, and you test them on Monday morning
when the lab opens, you'll find no blood alcohol in their
system.

Perhaps
the most important factor to dealing with such a problem
is to try and keep a balance in your mind and heart as to:

what you want on an immediate basis (getting them to stop)

what you can do in terms of power over your child and enforcing your will on them (policing them 24/7 becomes increasingly difficult as they get older and become more independent)

and what your child needs to learn and accomplish on a long term basis (they have to make some mistakes in growing up, and hopefully any price they pay in the process will not be too high).

There are some factors which probably are working in your
favor. First, I usually find the age where kids are starting
to get in to drinking or using drugs as being from about 14-17
years old. Rarely do I see someone who has a full-blown problem
with alcohol or drugs at that age. Most kids I see are experimenting
to varying degrees, and there has been less opportunity and
time in which serious damage to their health or legal standing
may have occurred.

Secondly,
at least until a child is 18, or roughly till they are out
of high school, you probably still have some authoritative
and parental power over them. They may not like being dragged
to see a doctor or counselor, but most will still go with
you, albeit grumbling a bit. And as long as they remain minors,
you have legal authority over their lives too, and can take
charge of their receiving treatment.

Third,
if you can keep a fairly even emotional keel over the substance
abuse that is occurring - that is, try not to shout and berate
- you increase the likelihood that some communication can
occur between you and your child which can be helpful in resolving
the problems. It may be easier to maintain such an emotional
balance with the help of a professional substance abuse therapist,
who can facilitate open communication, be a mediator, and
guide you in the right direction.

The
types of therapists and programs that are available are diverse.
They range from Alcoholics Anonymous (AA, and Al-A-Teen),
to social workers, psychologists, and psychiatrists. There
are out-patient and in-patient programs for education as well
as detox, if that is needed. MADD and SADD (Mothers against
drunk driving; Students against drunk driving) also exist.
You may want to consult your family physician, clergy person,
or the Yellow Pages for more specific recommendations as to
whom you might contact.

Two
final points need to be made here. I do not wish to minimize
the risk that can occur from a kid using alcohol or drugs.
Anyone who is using needles to inject drugs may run the risk
of contracting diseases like hepatitis or HIV. Some drugs,
such as cocaine and ecstasy, can cause serious harm to a person,
such as brain damage, in a surprisingly short time. Alcohol
can have tragic consequences such as from drunk driving accidents
where a car load full of teens may result in them being maimed
or killed. Given the potential of serious consequences from
teen substance abuse, when you learn your child is engaging
in drinking or using drugs, you do need to act, and not merely
dismiss it as something that will take care of itself.

The
final point is that in North Carolina a person is considered
a legal adult at the age of 18, unless a judge has adjudicated
otherwise. You may be housing, feeding, and paying all their
bills, offering love and care, and still thinking of them
as a child. But, as soon as they turn 18 under state law you
no longer have legal authority over them. What this means
is that they have the legal right to say 'no' to your wanting
them to start a treatment, such as seeing a therapist. Your
child also has to give written permission for professionals
treating them to share information with you, such as if they
are using illegal drugs. You may still have other types of
non-legal authority over your children, based on factors like
trust, communication and the overall quality of your relationship.back
to top

What is mental retardation?

Mental retardation (MR) is typically defined with two key components. One is IQ score, based on an individually administered test given by a psychologist, which requires that it be below 70. The other component is that the person have significant difficulty in handling various life skills. These can include abilities such as:

communication

self-care (hygiene, eating, etc.)

social skills

work

leisure

health

safety

traveling around the community by car or public transportation

There was a time in the past that once someone was labeled as being mentally retarded they were warehoused in facilities such as psychiatric hospitals. Thankfully those days are over. But, making the diagnosis is still important. There are a number of kids I have seen over the years where the parents had high hopes and expectations that the child would go to college and develop a professional career. But, when dealing with kids who have limited intelligence such dreams are not realistic. Instead, it is important to put the child on a vocational track. Doing so helps prepare the child to become more independent in a manner they can handle. And, it also allows the parents to seek out additional support while the child is still in school, and even beyond such as in early adulthood through additional vocational training. When individuals have more severe mental retardation, and the child is not expected ever to become fully independent and self-sufficient, such a diagnosis may also help the parents take the necessary legal steps to insure their child is cared for by others when they can no longer do so.

My elderly parent is claiming to see things that aren’t there, like bugs or people in the room. Or thinks there are people living under the bed or up in the attic. What’s going on?

There are different possibilities that may be responsible for such phenomena. One is that when a person’s vision deteriorates such as from glaucoma, cataracts, or macular degeneration, their ability to see and distinguish what is around them will obviously be lessened. With such poor eyesight shadows that do exist in the room, whether they are from interior objects, or cast by something outside like a tree’s branch may take on seemingly real shapes such as a person. Couple the poor vision with an aging mind, that is not thinking as quickly or clearly as possible, and the type of complaint you mention, of ‘seeing people who aren’t there’ is easier to understand.

As to the ‘person living under the bed’ or ‘the family living in the attic’, one possible culprit is the presence of delirium. What can bring on delirium? There are dozens of possibilities.

The biology of life requires a lot of stability, such as our body temperatures remaining fairly constant. The blood levels of sodium and potassium, pH, sugar, and many other components also need to be tightly regulated. Our organs, such as kidneys, liver, heart and lungs have to function well enough to supply nutrients like oxygen, and effectively remove toxins from our system. When any of those tightly regulated processes becomes defective we have problems. Organs age and break down. Infections including something as seemingly innocuous as one in the urinary tract (UTI’s) can throw a monkey wrench in to part of our biological processes.

Still other possible causes of delirium include medication side effects. In my experience after roughly the age of 60 people are virtually guaranteed to have trouble with tolerating different prescription medications. And the problem grows worse with increasing age, in to the 70’s, 80’s or beyond. Unfortunately, as our bodies tolerate medication less well doctors are prescribing ever more pills to treat the increasing health problems that arise with advancing age. At some point that becomes a recipe for pushing a person ‘over the edge’ and delirium results.

Other common causes of delirium can include recent surgeries, even for seemingly routine issues like hip replacement, which is another way to stress an aged body too much. Dietary problems arise, especially with individuals who live alone. Many elderly women have what I call ‘tea and toast’ diets which are far from being well balanced nutritionally. Others may eat better, but their bodies ability to digest and absorb food deteriorates with age, and so nutritional deficiencies still result.

Determining what is occurring to cause the delirium is very important. Delirium is symptomatic of some life threatening process being present, so that some needed biological stability has been lost. An evaluation by a family doctor, psychiatrist or neuropsychologist is strongly advised, sooner rather than later.

Psych testing as it is commonly referred encompasses a very broad spectrum. The two most common in the U.S. are for intelligence (IQ) and personality.

IQ testing can be done for a variety of reasons. Among school age children it may be requested if a kid is not learning up to par. Sometimes the request is to diagnose a problem, such as mental retardation. Once diagnosed, the child is eligible for special services in the school system. One way to diagnose learning disabilities has been to compare a child’s IQ to various academic skills such as reading or math. Generally, intelligence and academic abilities are commensurate with each other. When there is a wide disparity with the academic much weaker, a diagnosis of learning disability can be supported. However, schools are moving away from such a method of LD diagnosis.

Personality assessment can be done for numerous reasons. In some specialized settings, such as alcohol rehab centers, eating disorder clinics, or in-patient hospitals that may treat problems like schizophrenia, the assessment focus may be very narrow, on the particular issue that brought the individual to that facility.

However, many times people come to a psychologist and will say that they, or someone in their family such as a spouse, elderly parent, or child, is having problems and not living life as well, happily, or easily as they expect. In such situations the personality assessment will look at a wide range of possibilities to determine what is happening.

Other types of psych testing can include vocational, industrial/organizational (I/O), and forensic. Vocational assessments may be done on students finishing up high school and college, and looking for some help as to where their vocational interests and skills lie. Others who are making mid-career changes may be seeking the same information.

I/O assessments can involve issues like hiring, placement, or advancement. ‘Fitness for duty’ evaluations occur when a problem has arisen with someone already hired, and the employer needs to better understand what is happening, why, and what should be done. For instance, ‘threats of violence’ or being drunk on the job can trigger these types of evaluations.

Forensic evals cover a wide array of concerns. Some arise over insanity pleas. Others involve whether a person is even capable of standing trial (‘competency’ and ‘criminal responsibility’). Child custody concerns are another major part of forensic cases, where a judge wants to know which parent is (un)fit to care for a child.

Neuropsychological evaluations also exist, and have been detailed in another FAQ on this site.

My teenager is constantly playing video games. What are your thoughts about this?

It takes a long time to obtain definitive research on anything. This can include the connection between cigarette smoking and lung cancer, or the use of hormonal replacement therapy for post-menopausal women and health benefits. Typically 35-50 years are needed before the evidence becomes more conclusive. Video games have been around for 25-30 years. But they really exploded on the scene only in the last decade or so, with the advent of video game stations and more powerful computers. So, definitive research does not yet exist.

Preliminary research, and what I have seen in my own practice, is that kids who play a lot of video games have what I call ‘a well trained mouse clicking finger.’ Research phrases the benefits of video games as ‘stimulation to motor skills and vision.’ What this early research also finds is that what is not being activated are the frontal lobes. (See another FAQ in this section on frontal lobes as to their importance.)

Recent research also has found that around the adolescent years the brain starts paring back nerve connections. This can be likened to the pruning a gardener does to a shrub: having less is better, relative to getting rid of parts that are not contributing to health and vigor. Which brain connections are being pared back? ‘Use it or lose it’ might be the guiding principle. That is, if the mouse clicking region of the brain is being heavily employed, those connections will be preserved. If the region involved with reading or math are not getting much use, their connections may wither away. If such a pattern is occurring, this can have implications for the rest of a person’s life, as to how well developed certain skills are, such as for the 3 R’s of academics.

Other preliminary research in to video games has found that those individuals who played more aggressive video games had more aggressive delinquent behavior, poorer academic marks, more physical altercations with other students, and more numerous arguments with authority figures.

Given that video games permeate almost all homes in this country, what can you do if you’re concerned about this early research? Getting the games out of your home is one solution, but your child’s friends will inevitably have them. A major fight with your child may also result. Restricting access to the games, physically or relative to the number of hours played per day or week, is a second option. Enforcing that can be difficult especially if you’re not always home when your child is. A third approach might be trying to shift their interest by encouraging something healthier. This principle is often employed by people who try dieting. If all you have for snacks are potato chips and cookies, what will you eat when you’re hungry? If you have carrot sticks and fresh fruit handy and within reach, what might you eat? If recreational time in your home encourages conversation, playing Scrabble, or going for a walk or bike ride with your child, video games may lose some of their sway and influence.